“VERTIGO and the PATIENT PROTECTION and AFFORDABLE CARE ACT ARE TURNING MY LIFE UPSIDE DOWN!”
Went out to Vegas last October and somewhere during the 5 hour and 40 minute trip, my ears must have decided without me knowing to wreak a little havoc. That evening I woke up in the middle of the night and the room was spinning faster than a disco ball at Brooklyn’s Odyssey 2000. (for all you “Saturday Night Fever” fans) I didn’t pay it any mind thinking it was my mother’s tuna casserole not agreeing with my brain when I agreed to eat it. However, after I got back home to New Jersey, it happened 3 more times in the course of the next 10 days. It was time to see my Primary Care Doctor.
I had not been to the PCP in about 15 months so when I called to make an appointment I was told, “Oh, he’s not practicing medicine anymore.” I found that odd, he being in his late 30s so I “googled” him cause that’s what everyone does these days and come to find out that he’s not practicing anymore because he was arrested, indicted and convicted of conspiracy to sell steroids to undercover cops and was accepting kickbacks from a pharmacy in Brooklyn. He had to surrender his medical license for a few years. You see, if Medicare reimbursements were a little higher, some doctors wouldn’t have to moonlight as criminals! So now I gotta go find a new PCP. I took a recommendation from a few folks in my office and made an appointment.
As we all know when we go to a new doctor, you are greeted with a friendly smile and a clipboard. Such was the case with me and I quietly sat down, neatly filled out the forms and presented them back along with my insurance I.D. card to the lady at the desk. Then something happened that had never happened to me before in a doctor’s office. She asked me for my $30.00 co-pay BEFORE I was even seen by the doctor. Taken aback, I replied, “Really? I usually pay after I’ve seen the doctor.” Her retort and her glare were swift and deadly. “It’s an office visit, what’s the difference? In this office you pay before.” It was at that moment I realized I was dealing with Conan the Barbarian’s little sister, Connie. Left hand visibly shaking, I wrote the check but decided to get in one more swipe “Did you know that the new Patient Protection and Affordable Care Act allows grants for doctors to upgrade their computers so that medical records can be easily transferred electronically? There was a lot of information on those forms you could have gotten from my previous doctor.” Her eyes slowly looked up at me over the glasses sitting on the bridge of her nose and replied, “No, that news bulletin hasn’t crossed my desk yet. Go have a seat and the doctor will be with you shortly.” So I turned, walked back to my seat, sat down, looked straight ahead with my hands folded in my lap and waited.
The doctor was actually very thorough, spent a good amount of time with me and came up with an initial diagnosis of Vertigo. Although my ears were clear, he noticed a bit of redness and concluded that I must have a small infection. “Give it a few days. It you have any more episodes of dizziness, come back and see me.”
The dizziness did subside but my ears felt constantly clogged. I went back and the doctor again examined me very thoroughly but did not detect any blockages or inflammation. He recommended an over the counter decongestant. That seemed like a reasonable solution because I knew I could, under my FSA, get reimbursed. HOLD ON! NOT SO FAST!
Under PPACA, you can no longer get reimbursed for over the counter drugs unless the doctor writes a prescription for it. If Congress is going to repeal any other parts of this law, this one should be next in line. Previous to the enactment of PPACA, people would load up on Advil, band-aids and other qualified medical expenses to make sure they used up their entire account in the calendar year. Remember, FSAs have a “use it or lose it” rule that I think is also unfair. They should not only repeal the new FSA rules but they should allow for rollovers of up to $500.00. After all, it is the employee’s money.
My next encounter with Connie the Barbarian was to make an appointment for an annual “well visit.” So I called to make the appointment thinking, “wait till she asks me for my $30.00 co-pay. I’m gonna ram PPACA right down her throat. She has no idea that under the new law, well visits or preventive care are covered at 100%. Ah, revenge is so sweet!” Well sure enough I show up for my appointment. I sign in, stand there and wait, I am poised to pounce, ready to rumble, let’s go! She looks up, smiles and says, “ok, have a seat.” WHAT! Are you kidding me? I’m ready to dance, go ahead, ask for money, I dare you!” Nothing, not even an incredulous look. Just a “go sit down.” Completely deflated, I went into the waiting room, slumped in my chair and started arranging clipboards on the floor to spell out “PPACA.”
I had my well visit, everything is good. My vertigo seems to have happily disappeared. I did engage the doctor in some conversation regarding the new law. He is concerned about the big shortage of Primary Care Doctors in New Jersey and that there seems to be no desire for doctors to stay in NJ after they complete their schooling. He says that will cause him to see more patients which would mean spending less time with his current ones.
It is reasonable to assume that PPACA will not be repealed. Some parts of it will be but not the entire thing. Congress will certainly have a hard time de-funding the law as some grants have already been distributed to the states. The Feds are not going to get that money back. Regardless of your political preference, there are parts of this law that are good for people. The preventive care, wellness, Dep. To Age 26 clauses to name a few.
This bill turned out to be over 2,700 pages long with a potential 30,000 additional pages of regulation. That is far, far too much. Imagine downloading that onto your Nook or Kindle. The thing would explode in your hands!
It is crucial that, as brokers and advocates for our clients, we make sure they take advantage of the good things PPACA may offer. They need to be schooled by us what to do and what not to do when applying PPACA to certain insurance situations. They will turn to us for understanding and interpretation. It’s our job to deliver. They’ll appreciate the wisdom and it could lead to them taking more personal responsibility for their health and that of their families.
Whatever you think of PPACA, believe me it’s a whole lot better than tuna casserole!
Dave Mordo
